What is Tobacco 21 (T21) and why does it matter?
Tobacco use remains a major public health concern in Michigan, causing over 16,000 deaths each year. Compared to the national average, 20% more Michigan 12th graders have smoked a cigarette, smoked a cigar, used smokeless tobacco or vaped an e-cigarette in the last month. Of young people who smoke, 2 in 3 long-term users will die early of smoking-related causes.
While youth tobacco use rates have steadily declined for two decades, in 2018, e-cigarette use among young people rose so precipitously that the Surgeon General declared that vaping had become an epidemic among the nation’s youth. Nationally, 85% of daily smokers begin smoking daily before the age of 21.
In an effort to reduce tobacco use and prevent its detrimental health effects, T21 policies aim to limit youth access to tobacco products (including cigarettes, e-cigarettes and other tobacco products) by restricting sales to people aged 21 or over. More than 400 cities and counties and 7 states have adopted T21 policies.
In spite of the proliferation of T21 laws, there is little evidence around:
1. The potential public health impact of T21
2. The projected revenue effects of T21
3. Early challenges to T21 implementation
4. Youth’s views of T21
A team of researchers conducted a comprehensive policy analysis on the potential effects of T21 in Michigan. Project components included: policy effect simulation analyses, case studies of 4 Ohio communities that have implemented T21 and a national text message survey of people aged 14–24, in partnership with MyVoice. The research team is based at the University of Michigan and is affiliated with the School of Public Health and the Institute for Healthcare Policy & Innovation (IHPI). This project was supported by IHPI through the Policy Sprint initiative.
TAKEAWAYS FROM OUR RESEARCH AND POLICY CONSIDERATIONS
1. Health and revenue implications for Michigan
Our research estimated the effects on the health and tax revenue collected in the state of Michigan if a statewide T21 policy was passed into law. The model examined how smoking habits would change over the next 80 years if T21 reduced smoking initiation by 10%, a figure supported by a 2015 Institute of Medicine report.
2. Views of young people
A national survey of nearly 800 people ages 14–24 was conducted in September 2018 via text message, with an over-sample of Michiganders. Our team evaluated the responses to understand attitudes towards tobacco use and opinions about T21.
3. Lessons from case studies in Ohio
Ohio provides useful lessons on T21 implementation in a comparable population to Michigan. Case studies, anchored by 23 stakeholder interviews with key stakeholders in the T21 policy process, were conducted in four Ohio cities (Columbus, Cleveland, Dublin and Euclid). Interviewees were asked about the process of creating, passing, implementing and enforcing T21 in their city. An additional review of local survey data, laws and policy materials was conducted to further understand the local context.
The bottom line:
Our research indicates that T21 policies can deliver health benefits in Michigan, if the policy is effectively implemented. Structuring policy adoption and implementation in a way that will be successful should be prioritized, as was seen through our case studies in Ohio.
This policy brief was supported by the IHPI Policy Sprint program, which provides funding and staff assistance to IHPI member-led teams in undertaking rapid analyses to address important health policy questions and develop products that inform decision-making at the local, state, or national level.
FOR MORE INFORMATION, please contact Eileen Kostanecki, IHPI’s Director of Policy Engagement & External Relations, at email@example.com or 202-554-0578.